HomeMy WebLinkAboutS2021-0198 - Permit ApplicationIi i iN�
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
1859 Port Carlow PI
LEGAL DESCRIPTION
LOT BLOCK
2. DESCRIPTION OF WORK Pool and Spa 480 sq ft
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION ,
TRACT
s2o21-n`�I�
ESTIMATED $ VALUATION 40000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE EZ
('_hark Annrnnriatp hnY fnr Annlicant
❑ 3. OWNER'S NAME LAST FIRST
Debons
ADDRESS
OWNER'S E-MAIL ADDRESS
1859 Port Carlow PI
CITY STATE ZIP
PHONE NO.
Newport Beach Ca 92660
949.554.5232
❑ 4. ENGINEER'S NAME LAST FIRST
LICENSE NO.
Lacher Todd
167656
ADDRESS
ENGINEER'S E-MAIL ADDRESS
1201 N Tustin Ave
CITY STATE ZIP
PHONE NO.
Anaheim Ca 92807
1714.630.6100
® 5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
Infinity Pools
No. 891370 Class C5
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
28295 Camino Estribo
CITY STATE ZIP
PHONE NO.
Temecula Ca 92590
714.262.9164
OFFICE USE ONLY
PERMIT NO. 3U2_1 �iq$
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
FormsWool spa appl (rev3-04).x1s